| NPI | 1336602408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 105237) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 105237) |
| Enumeration Date | 2019-04-07 |
| Last Update Date | 2023-07-23 |